Hypertension

Question 1

What is ambulatory BP monitoring and when is it indicated

Answer 1

Indicated : when BP between 140/90 - 180/120 mmHg
It takes 2 measurements per hour between patient’s hours

Question 2

What is Home BP monitoring carried out?

Answer 2

2 measurements at least 1 minute apart
Twice a day - BD morning and evening for 4-7 days

Question 3

What is the diagnostic criteria for hypertension?

Answer 3

• > 140/90 mmHg
• > A/HBPM average >135/80

Question 4

What is ‘Stage 1’ Hypertension?

Answer 4

• 140-150 / 90-99
• A/HBPM 135/149 / 85 - 95

Question 5

What is ‘Stage 2’ Hypertension?

Answer 5

160-179 / 100-119
AND
A/HBPM 150/95 or higher

Question 6

What is ‘Stage 3’ Hypertension?

Answer 6

SBP>180 or DBP >120 mmHg chronically

Question 7

What is the ‘Step 1’ management of hypertension?

Answer 7

• < 55 y or T2DM
  } Ace-inhibitor (Ramipril) /ARB
• > 55 years or Afro/Carribean
  } CCB (Amlodipine)

Question 8

What are the main side effects of calcium channel blockers?(5)

(5)

Answer 8

• Ankle oedema secondary to dilation,
• headache
• flushing
• gingival hyperplasia
• constipation
  Nifedipine : causes ulcers

Question 9

What is the ‘Step 2’ management of hypertension?

Answer 9

• < 55 years OR T2 diabetes mellitus
  Ace inhibitor / ARB + CCB
  Or
  Ace inhibitor + Thiadize like diuretics (Indapamide)
• > 55 years or Afro/Caribbean
  CCB (amlodipine) + Ace inhibitor
  Or
  CCB + Thiazide like diuretics

Question 10

What is the ‘Step 3’ management of hypertension?

Answer 10

Ace inhibitor + CCB + Thiazide like diuretics

Answer 11

MOA : act on distal convoluted tubule of the nephron in the kidneys.
* Inhibit the sodium-chloride symporter (NCC), a transporter responsible for the reabsorption of sodium and chloride ions.
* Higher Na+ in DCT enhances Ca2+ reabsorption

By blocking this transporter, thiazide-like diuretics reduce the reabsorption of sodium, leading to increased sodium excretion in the urine.

Question 12

What are the side effects of Thiazide like diurteics

Answer 12

• Impotence,
• hyponatraemia
• hypercalcaemia
• Percipitates gout (hyperuricaemia)

Question 13

What is the ‘Step 4’ management of hypertension?

Answer 13

1. If K+ < 4.5
   - Add on Spirnolactone

2.If K+ > 4.5
Add on Beta blocker or Alpha blocker

Question 14

What are the endocrine causes of secondary hypertension?

Answer 14

• Acromegaly
• Hyperthyroidism
• Conn’s adenoma
• Ushings
• Phaeochromocytoma

Question 15

What are the renal causes of secondary hypertension?

Answer 15

• Adult polycystic kidney disease
• Renal artery stenosis
• Glomerularnephritis

Question 16

Hypertension Mx : Diabetes

Answer 16

1. T2DM `: 140/90 >
2. T1DM
   * 135/85 >
   * Albuminuria / >2 features of metabolic syndrome 130/80>